CMS-10394 QECP Phase 1 Data Source Attestation Requirements

QECP Phase 1 Data Source Attestation Requirements
The purpose of this document is to provide entities with a reference for submitting all information
regarding other-payer sources of claims data and the total number of covered lives in a QE's geographic
area.
For the five largest data suppliers provide:
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Legal name of claims data supplier
Trade name/DBA
Effective dates of agreement
Website URL
Are individual providers identified in the claims data received from this supplier?
Volume of other-payer data: what is the number of unique covered lives received from this data
supplier?
Geographic coverage area of data received from supplier to be included in QE performance
reports
o List state(s) in which your data and reporting cover the entire state:
o List state(s) in which your data and reporting cover only part of the state:
o For partial covered states, list counties, MSA or other regional boundary covered
Do you also receive pharmacy claims data from this supplier?
o If yes, describe volume:
o If yes, do you intend to incorporate this into your claims-based QE measures?
Are all of the claims received from this supplier pre-adjudicated?
o Does your organization plan to produce measures related to cost using data from this
supplier? Note: if all claims from this supplier are pre-adjudicated, the applicant is
unable to calculate cost measures.
Do you receive Medicare Advantage data from this supplier?
o If yes, is the Medicare Advantage data included in the replies to questions 1 and 2 for
this supplier?

Summary Profile for Additional Data Suppliers: provide the following aggregated information for the
remaining data suppliers relevant to the entity’s QE application and program.
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Total number of remaining data suppliers.
Names of all remaining data suppliers.
All suppliers have active effective dates of agreement (Y/N)
Total number of covered lives when adding all remaining covered lives from remaining data
suppliers together.
Total number of remaining data suppliers for which you also receive pharmacy level data.
Describe the volume of pharmacy claims received from the remaining data suppliers.
Individual providers in all remaining data sources are identified. (Y/N)
Plan to calculate cost measures with pre-adjudicated data
Is Medicare Advantage data included in claims received from remaining data suppliers? (Y/N)
End of QECP Phase 1 Data Source Attestation Requirements